Sunday, April 22, 2012

The Mayo Clinic in Rochester, MN, has introduced two new insurance programs. That wouldn't be very newsworthy except that the insurance programs aren't being offered to Americans, they're being offered to Canadians, who already have access to "free" medical care in their home country.

With the addition of the two new programs, the Mayo Clinic will now be marketing three insurance programs to Canadians:

• MyCare Insurance for individual Canadians, which was introduced in May 2011 to supplement Canada's "free" medical care.

According to the Mayo Clinic, 25% of the international patients they serve every year are from Canada. And why is an American hospital/clinic serving so many Canadians?

According to this news report about Mayo's insurance programs for Canadians, "the publicly funded health system in Canada decreases the choices available to patients, and can also result in delayed diagnosis and treatment. That's why, within the national system, it's good to offer choices for
those who need diagnosis confirmation or even treatment for serious
illness."

Living in both countries, I've personally found that US healthcare is much more expensive, but generally not much better than Canada's universal coverage.

That may be true for instances that do not really require a doctor or are minor in nature but not true for life threatening conditions where treatment is too slow or unavailable in time to save your life. People don't complain because they died from something that would not have been terminal if the proper care was available on time.

Universal Health care does NOT mean you can get whatever care you want for free whenever you want.

It's the basic safety net for everyone and if you want "better", then you are free to pay extra for it.

To continue to imply that universal health care "fails" or "does not work" because people have to come to the US to get care continues the big lie about US health care.

the goal of universal health care was never to provide any/all level of desired (or even needed) care for anyone no matter the costs.

the goal of universal health care is to provide a basic level of care to everyone - for a price - paid for by each person via "individual mandate".

that basic health care does NOT entitle you to any/all healthcare you want/desire or need.

For instance, Medicare IS universally available to seniors but it not only has a 20% co-pay, it does not cover everything either.if you need glasses or teeth work,cosmetic, etc you're on your own.

if your hip replacement costs 20K, you're share is 4K and you can't get it just because you want it - you need a doctor to say so.

It's similar in countries that offer universal access to their whole population. You don't get everything you want or even need. You get BASIC health care and you put more skin in the game if you want more/better - as you should.

In the US, we also offer "stealth" Universal health care via EMTALA and MedicAid that the rest of us pay through the nose via higher insurance costs because hospitals "cost-shift" their EMTALA costs and all of us pay more in Fed and State taxes to fund MedicAid - which is the largest growing Fed and State budget expenditure.

This is a very interesting trend in healthcare. The outsourcing of health services to places somewhere in the world where prices are much lower. Quality is my biggest concern here. Although in the end this trend may help moderate the severe inflation occurring in the price of healthcare services. Healthcare providers will be forced to become more Efficient in order to retain their customers. The biggest beneficiary will be those using the healthcare system. This trend if it continues and really expands will most certainly mean lower prices and better services for consumers of healthcare services. In addition to this money that would have been increasing going into the healthcare system will now be flowing into other sectors of the economy. A positive economic development.

I work in health care in the USA near the Canadian border. Most Canadians I speak to are completely satisfied with their system.

My experience is that very rich Canadians come to the states for certain procedures and these procedures are rarely emergent in nature. I've heard the Arabic billionaires use the French health care system much more than the American systems.

The reality is most health care does not involve high tech equipment or need super-fast service and a large percentage of surgical procedures are recommended because the physician has bills to pay too.

Universal Health care does NOT mean you can get whatever care you want for free whenever you want.

It also means that essential services will be denied to people who need them because the resources are not available.

It's the basic safety net for everyone and if you want "better", then you are free to pay extra for it.

But in Canada you can't pay extra. That would be considered giving an advantage to rich people. Only people who know people in the medical sector or politicians can get service any time they wish to.

To continue to imply that universal health care "fails" or "does not work" because people have to come to the US to get care continues the big lie about US health care.

No. It fails because when you give something away for 'free' you run out of resources very quickly.

the goal of universal health care was never to provide any/all level of desired (or even needed) care for anyone no matter the costs.

Correct. It is to ration care as the government decides. The doctors and patients have little say in it.

the goal of universal health care is to provide a basic level of care to everyone - for a price - paid for by each person via "individual mandate".

No, it isn't. The individual mandate is something that was 'given' to the insurance industry to gain support for Obamacare. They want to have all those young people who do not choose to purchase care have to pay for insurance that they do not want or need.

The reality is most health care does not involve high tech equipment or need super-fast service and a large percentage of surgical procedures are recommended because the physician has bills to pay too.

In the US there is a liability issue that forces doctors to engage in defensive medicine. The problem in Canada is scarcity for those that need super-fast service. They can easily pass the point of no return before they access a specialist who could have saved their life or had access to better equipment.

VangelV has left a new comment on the post "U.S.-Based Mayo Clinic Offers Three Medical Insura...":

Universal Health care does NOT mean you can get whatever care you want for free whenever you want.

It also means that essential services will be denied to people who need them because the resources are not available.

really? in every single case? What about Singapore?

and when you say essential services denied - what about people who live in places without UHC? are they denied essential services?

It's the basic safety net for everyone and if you want "better", then you are free to pay extra for it.

But in Canada you can't pay extra. That would be considered giving an advantage to rich people. Only people who know people in the medical sector or politicians can get service any time they wish to.

My understanding is that you can but it's restrictive - but you are FREE to go anywhere else.

To continue to imply that universal health care "fails" or "does not work" because people have to come to the US to get care continues the big lie about US health care.

No. It fails because when you give something away for 'free' you run out of resources very quickly.

you're not giving it away "free" when you have an individual mandate - payroll taxes to pay for it.

the goal of universal health care was never to provide any/all level of desired (or even needed) care for anyone no matter the costs.

Correct. It is to ration care as the government decides. The doctors and patients have little say in it.

not true. the reality is that ALL health care IS rationed no matter the system,

the goal of universal health care is to provide a basic level of care to everyone - for a price - paid for by each person via "individual mandate".

No, it isn't. The individual mandate is something that was 'given' to the insurance industry to gain support for Obamacare. They want to have all those young people who do not choose to purchase care have to pay for insurance that they do not want or need.

every single G20 country has an individual mandate. Germany, for instance since 1900 ... Singapore has mandates also... every single country with UHC has such mandates.

.....

As I wrote above, your ignorance is showing again.

blah blah blah

The reality is most health care does not involve high tech equipment or need super-fast service and a large percentage of surgical procedures are recommended because the physician has bills to pay too.

are you including Europe/Asia in that assessment where an MRI is 1/10th the cost of here?

In the US there is a liability issue that forces doctors to engage in defensive medicine. The problem in Canada is scarcity for those that need super-fast service. They can easily pass the point of no return before they access a specialist who could have saved their life or had access to better equipment.

and when you say essential services denied - what about people who live in places without UHC? are they denied essential services?

UHC sets limits on treatment. End of story. If you want more you have to spend your own money. In places like Singapore you pay out of your own health account, which provides an incentive to think before you ask for 'free' test to be performed or to go into a hospital for minor problems that do not require any medical attention. A place like Canada has much longer wait lines because people have no incentive to use the services prudently.

My understanding is that you can but it's restrictive - but you are FREE to go anywhere else.

Yes, you are free to go to another country to seek treatment that is not offered in a timely fashion in Canada. That hurts the poor who have no means to go abroad for medical care and no connections to skip to the front of the line. Luckily for most of us there are few serious conditions in our lives and many of those are not treatable even if the best care were available in time. For us the issue is the huge cost of waiting for that care. Again that hurts the poor who have to lose pay because they are stuck for hours in waiting rooms and need to make many more trips than they would have if proper access were possible.

you're not giving it away "free" when you have an individual mandate - payroll taxes to pay for it.

You are missing the point. You have to pay for the care even if you do not use it or have no need because of your age and status. That means that there is little incentive to be prudent getting care. So you see doctors offices filled with people who are not really sick or have conditions that are not treatable with medication but will go away on their own. Those visits require all kinds of testing be done to protect the doctor from lawsuits. And those tests are very expensive. Eventually the government will limit those tests but when that happens some people who actually need them will be denied and will be asked to pay in addition to the insurance premiums. If you are poor you may not be able to afford to pay for those tests and will reject the recommendation of the doctor.

Mandates do not work as well as simple competition. If you let the insurance companies compete across state lines and offer a wide variety of plans depending on market demand and if you get rid of the conditions that force doctors to practice defensive medicine and allow nurse practitioners to compete for routine services the cost of care would fall sharply while the quality goes up. But that is not something palatable to the lefties that believe in central planning or the right wingers who have acted to prevent competition in the medical sector.

not true. the reality is that ALL health care IS rationed no matter the system,

Buy a dictionary and look up the meaning of the word ration. One of my friends in France had a patient pay him a quarter million to ensure that his daughter's pregnancy went off without a hitch. He makes house calls and offers a level of personal service that you cannot imagine. That is not rationing. But if you are a part of the basic system you do have rationing.

every single G20 country has an individual mandate. Germany, for instance since 1900 ... Singapore has mandates also... every single country with UHC has such mandates.

They also have public school systems. That does not mean that public schools are a good idea.

are you including Europe/Asia in that assessment where an MRI is 1/10th the cost of here?

Cite your source for pricing please. I do not believe that there is uniform pricing in the US. It is possible to get an MRI that costs $1,000 at one hospital for $400 at a clinic a block away. Prices vary not only by location but by the type of scan being done, the parts of the body, etc. I doubt that you will find an MRI in London or Italy that will be done for $40, which is what one tenth of $400 comes out to.

You seem to be dazzled by accounting tricks. If a European doctor uses a machine that he has not paid for and does not have to worry about depreciation or overhead he may charge very little for an MRI or some other test. But that does not mean that the test is cheap. All it means is that someone else, usually the taxpayer, pays the rest of the cost.

tort issues are what in the other countries with UHC?

tort issues are just an excuse.

No they are not. It is very difficult to sue a Canadian or UK doctor compared to a US doctor. In fact, incompetent doctors often get to keep practicing long after they should have had their licences pulled. In the US incompetent doctors are either pushed out or have to work for the VA or take some other government job.

and when you say essential services denied - what about people who live in places without UHC? are they denied essential services?

UHC sets limits on treatment. End of story. If you want more you have to spend your own money.

doesn't MOST private insurance work the same way?

In places like Singapore you pay out of your own health account, which provides an incentive to think before you ask for 'free' test to be performed or to go into a hospital for minor problems that do not require any medical attention. A place like Canada has much longer wait lines because people have no incentive to use the services prudently.

Singapore requires you to pay into your HSA, right?

and if you wipe out your HSA, they then subsidize you...

My understanding is that you can but it's restrictive - but you are FREE to go anywhere else.

Yes, you are free to go to another country to seek treatment that is not offered in a timely fashion in Canada. That hurts the poor who have no means to go abroad for medical care and no connections to skip to the front of the line.

it hurts them FAR LESS than if they had NO insurance.

Luckily for most of us there are few serious conditions in our lives and many of those are not treatable even if the best care were available in time. For us the issue is the huge cost of waiting for that care. Again that hurts the poor who have to lose pay because they are stuck for hours in waiting rooms and need to make many more trips than they would have if proper access were possible.

the poor have "forever" wait times in countries without UHC. Anyone who has the resources whether they are in a country with UHC or not - can "buy down" wait times.

You are missing the point. You have to pay for the care even if you do not use it or have no need because of your age and status.

that's the ESSENCE of ANY Insurance.without a state requirement for auto insurance, what would happen to the folks who chose to not buy insurance unless forced to?

That means that there is little incentive to be prudent getting care. So you see doctors offices filled with people who are not really sick or have conditions that are not treatable with medication but will go away on their own. Those visits require all kinds of testing be done to protect the doctor from lawsuits.

the doctors MAKE MONEY from ordering tests and procedures also.

And those tests are very expensive. Eventually the government will limit those tests but when that happens some people who actually need them will be denied and will be asked to pay in addition to the insurance premiums.

but you keep forgetting about the people who don't get ANY tests until they are sick and THEN you and I will pay for their care. That's why we pay twice as much for health care in this country., You and I pay through the nose for cost-shifting and MedicAid.

If you are poor you may not be able to afford to pay for those tests and will reject the recommendation of the doctor.

Mandates do not work as well as simple competition.

huh? Every single G20 country has UHC.

name the top countries that do not that do better with competition alone.

If you let the insurance companies compete across state lines and offer a wide variety of plans depending on market demand and if you get rid of the conditions that force doctors to practice defensive medicine and allow nurse practitioners to compete for routine services the cost of care would fall sharply while the quality goes up. But that is not something palatable to the lefties that believe in central planning or the right wingers who have acted to prevent competition in the medical sector.

It's called 'adverse selection'.

how do you fix that?

I'm ALL FOR full-up competition. It's one reason I support standardized electronic medical records that are accepted by all providers.

but you still have the problem of people who get expensive conditions and the insurance companies will not sell them insurance and the ones that do have it and cost them too much money, get dumped.

you want to fix it?

tax all employer-provided health insurance as compensation and then take away the 8.5% of AGI on taxes for health care costs.

but if you don't control costs, more and more people will not owe taxes because they'll be deducting health care as an expense.

not true. the reality is that ALL health care IS rationed no matter the system,

Buy a dictionary and look up the meaning of the word ration. One of my friends in France had a patient pay him a quarter million to ensure that his daughter's pregnancy went off without a hitch. He makes house calls and offers a level of personal service that you cannot imagine. That is not rationing. But if you are a part of the basic system you do have rationing.

you have rationing no matter what unless you are willing to able to buy it down.

that's the reality.

every single G20 country has an individual mandate. Germany, for instance since 1900 ... Singapore has mandates also... every single country with UHC has such mandates.

They also have public school systems. That does not mean that public schools are a good idea.

it's the reality though and every single G20 country with public schools beats the snot of us academically - as well as every other country without public schools.

are you including Europe/Asia in that assessment where an MRI is 1/10th the cost of here?

I do not believe that there is uniform pricing in the US. It is possible to get an MRI that costs $1,000 at one hospital for $400 at a clinic a block away.

not in many states .. and not where Medicare is in play.

Prices vary not only by location but by the type of scan being done, the parts of the body, etc. I doubt that you will find an MRI in London or Italy that will be done for $40, which is what one tenth of $400 comes out to.

1/10th was too aggressive.. I'll back down to "substantial".

You seem to be dazzled by accounting tricks. If a European doctor uses a machine that he has not paid for and does not have to worry about depreciation or overhead he may charge very little for an MRI or some other test. But that does not mean that the test is cheap. All it means is that someone else, usually the taxpayer, pays the rest of the cost.

well yes..but overall.. their costs are 1/2 ours... not only Europe, but Asia and Oceania.

tort issues are what in the other countries with UHC?

tort issues are just an excuse.

No they are not. It is very difficult to sue a Canadian or UK doctor compared to a US doctor. In fact, incompetent doctors often get to keep practicing long after they should have had their licences pulled. In the US incompetent doctors are either pushed out or have to work for the VA or take some other government job.

Would you agree to UHC if we totally addressed the tort issue?

No. I believe in competition, not monopoly and central planning.

that's what I thought. Tort reform is really just an excuse. Even if it were fixed, you'd still be opposed.

No. In a competitive system, think auto and home, you can get all kinds of choices about coverage depending on your needs and your preferences. A mandate would be a one size fits all approach.

Singapore requires you to pay into your HSA, right?

and if you wipe out your HSA, they then subsidize you...

Most people are not stupid. They care about running out of cash in their HSA and about having options. Which is why they do not bother much with defensive medicine or unneeded medical care. People suffering with a cold in Singapore are far less likely to wind up in an emergency room or doctor's office because they have to pay out of their own accounts.

it hurts them FAR LESS than if they had NO insurance.

You don't understand the history of medical care systems. The private hospitals jumped at the chance to have provincial insurance because the provinces paid their bills. Many people who had used their services could not afford to pay. In your country doctors also gave away some of their services for free or volunteered in charity hospitals that offered care for the poor. There were also fraternal and mutual societies that provided care for their members. The government did not provide anything new. It simply pushed aside the private institutions that provided care for the poor as it expanded its size and power.

I suggest reading and learning because your ignorance is showing up each time you post.

No. Employers do not have to offer medical insurance to their employees but everyone has to buy their own coverage.

the doctors MAKE MONEY from ordering tests and procedures also.

If you had to pay for an unnecessary test you would be pissed off. Why aren't you pissed off because the payment comes from a pool to which you contribute?

but you keep forgetting about the people who don't get ANY tests until they are sick and THEN you and I will pay for their care. That's why we pay twice as much for health care in this country., You and I pay through the nose for cost-shifting and MedicAid.

You are missing the point. A woman who dies of breast cancer at age 62 will still die of cancer around the same age even if 62 if she detected it sooner.

Early detection means you live longer from the point of the detection but not necessarily from extending your life. If the discovery was made at 60 she has two years to live. If it were made at 55 she has seven years to live. The big difference is that she didn't know for five years that she had a cancer that would kill her at 62. And for those five years she would not be spending money on medical care and would be living a normal life free of worry or disruptions.

Now you could claim that some people are saved and that would be true. But as my doctor points out we have cancers in our bodies regularly and our bodies tend to deal with them. If a cancer that was detected early and went away with treatment it would be counted as a cure. But a cancer that was in one's body and went away on its own because it was never detected is not counted as a cure. And some cancers can be cured even if found later in the game.

When you put it all together there is little in the way of saving from some testing procedures because when you add everything up you don't see a material difference in the money spent. I think that was one of the points from the how doctors choose to die article. Try reading it again and think about all of the implications and the logic.

name the top 3 competitive health care systems in the world that are as good or better than the G20 UHC systems.

Im my life depended on it I would rather get care that I chose in HK, Singapore, Thailand, China, Panama, Mexico or India than in what the system assigns to me in the UK or Canada. My brother just had a stroke. Thanks to the quick thinking of a friend who forced to ambulance to take him to a different hospital his life was saved and the damage was limited. The problem was that the system kicked him out of the hospital best able to look after him and sent him to a crappy one where he had to wait for a week to be reassigned. As a result he is in worse shape today than he was four weeks ago when he had gone through a few days of therapy at the first hospital. Based on the assessment of a doctor friend of his he was set back around six weeks because the system would not allow him to stay in a public hospital that was not in his district.

It is easy to be supportive of a system that promises a lot. But what matters in the real world is performance. And on that front we see a total failure of the centrally planned monopoly systems that you favour whether they are in education, mail delivery, telecommunications, or health care. Time to grow up and see the way things are.

No. Employers do not have to offer medical insurance to their employees but everyone has to buy their own coverage.

they don't "offer" social security either but they have to collect payroll taxes for it.

the doctors MAKE MONEY from ordering tests and procedures also.

If you had to pay for an unnecessary test you would be pissed off. Why aren't you pissed off because the payment comes from a pool to which you contribute?

are you opposed to insurance?

but you keep forgetting about the people who don't get ANY tests until they are sick and THEN you and I will pay for their care. That's why we pay twice as much for health care in this country., You and I pay through the nose for cost-shifting and MedicAid.

You are missing the point. A woman who dies of breast cancer at age 62 will still die of cancer around the same age even if 62 if she detected it sooner.

a women of 30 cannot detect it early and be cured of it?

A kid with a heart defect cannot have it diagnosed and fixed and live to be 80?

Early detection means you live longer from the point of the detection but not necessarily from extending your life.

but in a lot of cases, YES it DOES extend your life. The whole idea of medicine is to find cures for diseases - but unless you detect it, it cannot be cured.

If the discovery was made at 60 she has two years to live. If it were made at 55 she has seven years to live. The big difference is that she didn't know for five years that she had a cancer that would kill her at 62. And for those five years she would not be spending money on medical care and would be living a normal life free of worry or disruptions.

you're assuming stuff that you cannot know - for everyone. Would you advocate NOT giving kids vaccines because only some of them would die without it?

Now you could claim that some people are saved and that would be true. But as my doctor points out we have cancers in our bodies regularly and our bodies tend to deal with them. If a cancer that was detected early and went away with treatment it would be counted as a cure. But a cancer that was in one's body and went away on its own because it was never detected is not counted as a cure. And some cancers can be cured even if found later in the game.

many diseases that ARE curable can be cured if they are caught early.

we don't know everything we need to know about cancer but if you look at a mole changing shape on your arm - you are less than smart if you ignore it.

When you put it all together there is little in the way of saving from some testing procedures because when you add everything up you don't see a material difference in the money spent.

Lord man. Are you familiar with chronic disease like Type II diabetes?

I think that was one of the points from the how doctors choose to die article. Try reading it again and think about all of the implications and the logic.

you got WAY MORE of the article than what it said guy.

It was NOT an article about ignoring your health because it's pre-ordained.

and that's why I asked you to provide real comparative data showing that non-UHC systems top the UHC systems in key and important metrics.

you have none.

you're making decisions not based on facts but your own views and anecdotal data.

I asked to to support your view that non-UHC systems are better.

you've totally bailed on that.

You give an interesting account of your brother and his travails but what does that have to do with the the overall facts?

We have several hospitals in our area as well as hundreds of doctors and there are ones that you never go to unless forced to.

but you say your brother was turned away? " The problem was that the system kicked him out of the hospital best able to look after him and sent him to a crappy one where he had to wait for a week to be reassigned."

they don't "offer" social security either but they have to collect payroll taxes for it.

Workers pay for the costs in the long run. Any payment coming from their employers is less than the employer can pay to the employee directly.

The way I read the plan when it first came out it called for employers that did not meaningfully contribute to their employee health care benefits to pay a percentage of their payroll to the federal government. The problem is that the bill gives many employers with good plans the incentive to drop them and pay a smaller amount to the government. That would mean that families will get less and wind up paying more.

One study I looked at a long time ago found that early detection did not mean a longer life. It simply meant knowingly living with the cancer for a longer period of time. And women who are 30 do not need testing unless they have a history of breast cancer in their family. All those unnecessary tests are taking resources from other uses.

A kid with a heart defect cannot have it diagnosed and fixed and live to be 80?

Of course. But we do not test every kid for heart disease every year. We only test when there are indications that there may be an issue. My argument is for all the battery of tests that are done because of the trial lawyers rather than prudence. On net those tests are a waste.

but in a lot of cases, YES it DOES extend your life. The whole idea of medicine is to find cures for diseases - but unless you detect it, it cannot be cured.

It does not work that way in most cases. Think of two fifty year old men who have cancer.

One is tested at 50 and finds it. He has treatments and his life is extended by 12 years. He dies at 62.

One is not tested until 60. He is also treated but the later stage treatment does not work as well and extends his life by only 2 years. They both died at 62 even though early detection gave one man an extra 12 years while the other only had two.

Or in another case two men of the same age have cancer in their bodies. One is diagnosed and cured. The other is not diagnosed but his body deals with the cancer.

they don't "offer" social security either but they have to collect payroll taxes for it.

Workers pay for the costs in the long run. Any payment coming from their employers is less than the employer can pay to the employee directly.

agree.. but that's the way that individual mandate works with UHC including in places like Singapore

The way I read the plan when it first came out it called for employers that did not meaningfully contribute to their employee health care benefits to pay a percentage of their payroll to the federal government. The problem is that the bill gives many employers with good plans the incentive to drop them and pay a smaller amount to the government. That would mean that families will get less and wind up paying more.

I think that in the end - employees pay.. and that should be understood by everyone. It's prepaying for insurance.

I keep asking you to name the countries who don't have central planning that are shown by clear evidence to be superior.

you don't like central planning but the reality is everything else is in second place...

a women of 30 cannot detect it early and be cured of it?

One study I looked at a long time ago found that early detection did not mean a longer life. It simply meant knowingly living with the cancer for a longer period of time. And women who are 30 do not need testing unless they have a history of breast cancer in their family. All those unnecessary tests are taking resources from other uses.

early detection saves lives and extends your life guy - not in 100% of cases but in a high percentage of cases. some things are pre-ordained. Many are not

A kid with a heart defect cannot have it diagnosed and fixed and live to be 80?

Of course. But we do not test every kid for heart disease every year. We only test when there are indications that there may be an issue. My argument is for all the battery of tests that are done because of the trial lawyers rather than prudence. On net those tests are a waste.

you need to have regular access in order for someone to determine a test is needed. If you don't have access..how do you know you don't need the test?

but in a lot of cases, YES it DOES extend your life. The whole idea of medicine is to find cures for diseases - but unless you detect it, it cannot be cured.

It does not work that way in most cases. Think of two fifty year old men who have cancer.

One is tested at 50 and finds it. He has treatments and his life is extended by 12 years. He dies at 62.

One is not tested until 60. He is also treated but the later stage treatment does not work as well and extends his life by only 2 years. They both died at 62 even though early detection gave one man an extra 12 years while the other only had two.

Or in another case two men of the same age have cancer in their bodies. One is diagnosed and cured. The other is not diagnosed but his body deals with the cancer.

there are thousands/millions of cases of people whose lives were saved and life extended because of intervention.

you're essentially arguing against the whole idea that a good medical system extends life expectancies. That's the primary indication of a 3rd world country - lower life expectancies.

See the problem with your argument?

I'm not sure where you are in life but you've gone astray on some basic facts about medicine in general and it's benefits to humans.

you seem to have a somewhat Luddite view but I've seen that in you before.

Good medicine results in longer lifespans.

not always, not every time and certainly exceptions but over the long run - medicine increases your life expectancy.

you're assuming stuff that you cannot know - for everyone. Would you advocate NOT giving kids vaccines because only some of them would die without it?

Not at all. I do not claim to know what is good for everyone because I do not force everyone to purchase the same insurance policy. I do not see why people who do not drink should buy policies that cover alcohol abuse or why strict Catholics should pay for premiums that cover morning after pills or abortions. I have no trouble with people choosing to vaccinate their kids if that is what they wish. I have no trouble with them purchasing insurance to pay for those vaccines or for them choosing to pay out of pocket. My problem is with forcing some gay couple who has no children to pay for your kids vaccinations through their premiums.

many diseases that ARE curable can be cured if they are caught early.

But we don't catch those diseases by testing people who are quite healthy and have no symptoms to suggest that they have them.

we don't know everything we need to know about cancer but if you look at a mole changing shape on your arm - you are less than smart if you ignore it.

I wouldn't ignore it. But it is not smart to keep doing tests to find skin cancer when there are no moles but you have a cold or headache. I know that economically ignorant people have trouble understanding this point but costs do matter.

That is because Americans do more tests and find the cancer sooner than the Europeans. The point is that this does not have much of an effect on the length of life, which is the point of medical care. It is why many American doctors choose to die differently than their patients.

VangelIV:"That is because Americans do more tests and find the cancer sooner than the Europeans. The point is that this does not have much of an effect on the length of life, which is the point of medical care."

Early detection of cancer is very important in treatment for many cancers. Scroll 1/3 of the way down the following link to see a graph showing 5-yr survival rates for detection at each stage of cancer. Early detection can save lives.

Larry G:"which makes it all the more curious that we score dead last in life expectancy for the G20."

There is only a year or two difference in average life expectancy between developed countries which is little substantial difference. Additionally, there are numerous factors that affect life expectancy unrelated to health care. Auto accidents, for example. If you account for these factors, the US comes out on top in life expectancy:

Early detection of cancer is very important in treatment for many cancers. Scroll 1/3 of the way down the following link to see a graph showing 5-yr survival rates for detection at each stage of cancer. Early detection can save lives.

Read carefully. Suppose you and I both have prostate cancer at age 52. You find yours at age 55 and have 'treatment'. You would be considered a 'success' even if the cancer finally gets you at age 82. I did not find my prostate cancer until I was 79. By that time it is too late to do radiation so we are left with surgery or hormone therapy. I choose hormones and die at age 82. Early detection 'wins' but we still died at the same age 30 years after the cancer first appeared in our system.

Now imagine doing all of the testing but not having the cancer until 68. The tests would be a waste of resources that could have been used better for other purposes. If the cancer first appeared at 68 the odds are that you would die from something else even if you chose not to take treatment.

Or imagine you do all of the testing for all kinds of cancers each year. Now you go in at 56 and find that you have pancreatic cancer. You found it in an early stage and there is a treatment that can extend your life by a few years. The odds of success are one in ten. Why would you even take the treatment if it means making your family a lot poorer and giving you a terrible existence for the five or six additional years before you die? Couldn't your family put the hundred grand or so in expenses to better use? Wouldn't it just be better to take them out on a celebratory cruise for a week and leave them with great memories instead of having them wish you dead because of all of the suffering?

Keep in mind that I am not arguing against testing when symptoms appear but against tests that try to find cancers in very early stages in individuals that have no symptoms. Defensive medicine may pay off for a few individuals but at a huge cost to most of us. If you understand economics and nature it isn't worth it.

A child with a serious heart defect can die 60 years earlier than if it is found and fixed.

you cannot find and fix it if the child does not visit the doctor on a regular basis and a competent doctor runs the right tests.

there is quite often raging controversy in the ranks of the organizations that look at the cost-benefits of early testing.

even highly skilled and educated professionals will disagree.

most agree - there is a defined set of measurements that need to be looked at once a year or so... to make sure they all are within nominal ranges.

A bad para-thyroid was found in my case through a routine test that showed high calcium levels.

it took some diagnostic effort - but that high calcium level eventually led to the discovery that one of the 4 para-thyroids had gone berserk and if left untreated had the potential to involve the thyroid itself.

That problem would likely never been found until way too late for people who do not visit the doctor on a regular basis and have routine blood testing done on an annual basis.

people without insurance will often forgo this.

one more thing - google "standard of care". It has relevance in this context.

A child with a serious heart defect can die 60 years earlier than if it is found and fixed.

True. But we don't test every child who has a cold for heart defects. That is my point. You do the tests when the symptoms indicate that there may be a problem. You do not use defensive testing to fish for undiagnosed problems.

you cannot find and fix it if the child does not visit the doctor on a regular basis and a competent doctor runs the right tests.

What do you mean by 'right tests?' To do a proper diagnosis you need all kinds of very sophisticated and expensive tests. If we routinely performed those tests on healthy individuals in the hope that we might find something a huge sum of money would be wasted without getting much in the way of a return. And even if we decided that the tests are necessary how do we find out the frequency that they should be performed for each specific individual? The fact that I might need cardio tests because I have a family history of heart trouble does not mean that you should have them done at all.

That is your problem again. You don't really give your statements much thought and analyze the implications. While that is not surprising for someone who believes in free lunches and unlimited resources coming from others it is not an approach that can be taken by rational people. And once government gets into the act it will not be taken by government either. You will see all kinds of testing not covered for most patients as bureaucrats with limited budgets figure out how to cut costs and ration the pool of available resources.

you send the child in for regular checkups Van - if you have insurance and it is "covered".

Do you think annual examples that include routine blood tests are not cost-effective?

What is the very first thing that your Doc does when he/she first see's you?

IN my case, it's check my BP and listen to my heart.

Most every doctor I see - does this no matter whether they are an endocrinologist or a cardiologist or my GP.

that's what a "check-up" means.

the determination of how much more "testing" to do has to do with the judgement of the Doctor but if you do not go at all.. there is no opportunity to even determine what further tests are or are not needed.

regular visits to the doctor are cost effective in the longer run for most people who are living beings ... people who do not do this have lower life expectancies, right?

annual checkups are considered prudent and cost effective so much that some companies pay for them for their employees.

you send the child in for regular checkups Van - if you have insurance and it is "covered".

The argument was about defensive medicine driving up American health care costs much higher without offering much of a return. A regular checkup does not require much in the way of special testing. But when you show up in an emergency room with a bad headache all kinds of tests are automatically triggered because the hospitals do not wish to be sued even when those tests are not warranted.

As usual your reading comprehension problems have caused you to miss the point.

VangelV:Prostate cancer isn't as treatable as other cancers. Early detection won't increase the chances of successfully treating the cancer. For this cancer, you're right that 5-yr survival statistics are skewed by early detection.

Other cancers, like breast and testicular cancer, are very treatable in early stages with chemo or surgery and very hard to treat in later stages where the cancer can spread. You can't lump all cancers in the same boat when it comes to the value of early detection.

"Why would you even take the treatment if it means making your family a lot poorer and giving you a terrible existence for the five or six additional years before you die?"

I don't know if I would or wouldn't want to take the chance. Each person has different risk levels. Some people would do anything they could to potentially survive and others would accept death and live their last years out without treatment. There's no universally correct answer.

"Defensive medicine may pay off for a few individuals but at a huge cost to most of us."

I agree. I've read studies that preventative medicine often costs more than the costs saved from early detection and treatment. There are also non-monetary costs to preventive medicine such as invasive tests and the stress that comes from worrying you might have a rare disease when chances are you don't.

I don't favor government mandates in health insurance or health coverage at all, and specifically not ones that dictate what preventative services should be provided.

That said, the US has more resources than many UHC countries to aid in early detection of cancer and is one of the reasons we have better 5-yr survival rates.

"Even when prevention greatly reduces future cases of a particular illness, overall cost to the health-care system typically goes up when lots of disease-preventing strategies are put into practice. This is usually true whether treating the preventable diseases is cheap or expensive. "

Strike what I said about the difficulty treating prostate cancer:"Because approximately 90% of all prostate cancers are detected in the local and regional stages, the cure rate for prostate cancer is very high—nearly 100% of men diagnosed at this stage will be disease-free after five years. By contrast, in the 1970s, only 67% of men diagnosed with local or regional prostate cancer were disease-free after five years. "

it's known as standard of care and it depends on circumstances and doctors judgement.

when you "show up in an ER" and they don't have your medical history because one does not exist because you do not have a regular doctor - you bet your butt that tests are going to be ordered.

reading comprehension problems?

It is you who has a problem. The doctors and industry have complained about all of the waste surrounding the defensive medicine that they are forced to practice. Yet you seem to know nothing about the subject. And still keep debating.

You could try learning my friend. That might make you more cautious and cause you to think before you post.

a doctor who treats you without knowing your history is playing with fire both in terms of your life, ethics, and the law - and they know it - that's why they order the tests if they cannot obtain your medical history.

Other cancers, like breast and testicular cancer, are very treatable in early stages with chemo or surgery and very hard to treat in later stages where the cancer can spread. You can't lump all cancers in the same boat when it comes to the value of early detection.

But you don't have to do all kinds of testing to detect these early. Do you do testicular cancer testing every year? And what about all of the cases of cancer where the body takes care of the problem without treatment? Scientists have known for some time that it is common to find some cancer cells or tumours in your system. Usually they are taken care of by the immune system without any need for external treatment. That is part of the problem with the data. Such cases are never counted when the cure takes place naturally because they were never detected in the first place.

And keep in mind what this debate is about. It is about the practice of defensive medicine, which consumes a huge amount of resources without much of a return. If we use all of those resources to help people in other areas we would wind up saving many more lives.

I have no problem with testing once there is something that is suspect and there are symptoms that need to be investigated. My problem is with using all of the battery of available tests to go on fishing expeditions particularly when doctors are driven by fear of lawsuits.

"Because approximately 90% of all prostate cancers are detected in the local and regional stages, the cure rate for prostate cancer is very high—nearly 100% of men diagnosed at this stage will be disease-free after five years. By contrast, in the 1970s, only 67% of men diagnosed with local or regional prostate cancer were disease-free after five years. "

But there is still a problem. For most men having slow growing prostate cancer is not an issue because they will die of something else long before the prostate cancer will kill them.

Your criticism that 5-yr survivability is skewed by early detection is still valid, though overstated, in my opinion.

You may be right and thought as most people did. But a while ago I read a commentary in one of the journals in which a doctor made the argument that I have given very persuasively. I believe that he used breast cancer data that was broken out in great detail. He showed that the benefits of testing were overstated significantly and argued that if all of the wasted money done on unnecessary testing on women who had no history of the disease in their families, were too young to be likely candidates, etc., were used on other medical research or treatment development there would be more lives saved. Yes, spending billions could wind up helping save a few lives. But the unnecessary treatments, worry, etc., in some cases where the tests were wrong would make lives of otherwise healthy women more difficult and the diversion of cash would prevent other lives from being saved.

My problem with all of the free lunch, central planning advocates is that they pretend that they know far more than they actually do and argue that they are in a better position to make decisions for other individuals than those individuals. Sorry but I don't buy that nonsense.

a doctor who treats you without knowing your history is playing with fire both in terms of your life, ethics, and the law - and they know it - that's why they order the tests if they cannot obtain your medical history.

you say read and learn.

do you know what Standard of Care means ... read up.

What nonsense. If I have a broken leg the doctor does not have to know my history to fix it. All he needs is the answer to a few simple questions.

As I pointed out this is about the huge cost of defensive medicine. That problem is well known yet is being ignored by you as you divert attention to trivia. That is not surprising because you have proved yourself to be one of the most trivial posters on this board.

Every single type of injury has a defined standard of care to include things like finding out if you are allergic to medicines, what other damaged including blood vessels and tendons, etc might be involved.. what your current CBC looks like in case you have other problems....that even you do not know about.

it's called due diligence and it's not trivial but your attitude indicates you really do not understand the difference between defensive medicine and competent medicine.

Doctors who do not "know" you are going to be reluctant to treat you until they "know" you better in terms of your current health status.